End-of-Life Healthcare Utilization in Lewy Body Dementia.

Background: Lewy body dementia (LBD) is the second most common neurodegenerative dementia in the US, presenting unique end-of-life challenges. Objective: This study examined healthcare utilization and care continuity in the last year of life in LBD. Methods: Medicare claims for enrollees with LBD, continuously enrolled in the year preceding death, were examined from 2011-2018. We assessed hospital stays, emergency department (ED) visits, intensive care unit (ICU) admissions, life-extending procedures, medications, and care continuity. Results: We identified 45,762 LBD decedents, predominantly female (51.8%), White (85.9%), with average age of 84.1 years (SD 7.5). There was a median of 2 ED visits (IQR 1-5) and 1 inpatient stay (IQR 0-2). Higher age was inversely associated with ICU stays (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI] 0.96-0.97) and life-extending procedures (OR 0.96; 95% CI 0.95-0.96). Black and Hispanic patients experienced higher rates of ED visits, inpatient hospitalizations, ICU admissions, life-extending procedures, and in-hospital deaths relative to White patients. On average, 15 (7.5) medications were prescribed in the last year. Enhanced care continuity correlated with reduced hospital (OR 0.72; 95% CI 0.70-0.74) and ED visits (OR 0.71; 95% CI 0.69-0.87) and fewer life-extending procedures (OR 0.71; 95% CI 0.64-0.79). Conclusions: This study underscored the complex healthcare needs of people with LBD during their final year, which was influenced by age and race. Care continuity may reduce hospital and ED visits and life-extending procedures.

Experiences with hospital-to-home transitions: perspectives from patients, family members and healthcare professionals. A systematic review and meta-synthesis of qualitative studies.

PURPOSE: Multiple studies have explored the needs and experiences of patients, family members, and healthcare professionals regarding hospital-to-home transitions. Our study aimed to identify, critically appraise, and summarize these studies in a qualitative meta-synthesis. MATERIALS AND METHODS: Medline, CINAHL and Embase were systematically searched to identify eligible articles from inception to June 2024. Qualitative studies were included and critically appraised using the Critical Appraisal Skills Program. Insufficient-quality papers were excluded. We performed a meta-synthesis following (1) open coding by two independent researchers and (2) discussing codes during reflexivity meetings. RESULTS: Ninety-eight studies were appraised, of which 53 were included. We reached thematic saturation, four themes were constructed: (1) care coordination and continuity, (2) communication, (3) patient and family involvement, and (4) individualized support and information exchange. For patients and families, tailored information and support are prerequisites for a seamless transition and an optimal recovery trajectory after hospital discharge. It is imperative that healthcare professionals communicate effectively within and across care settings to ensure multidisciplinary collaboration and care continuity. CONCLUSIONS: This study identifies essential elements of optimal transitional care. These findings could be supportive to researchers and healthcare professionals when (re)designing transitional care interventions to ensure care continuity after hospital discharge.

Patients and their families need to receive tailored information and support, which are prerequisites for a seamless transition from hospital to homeProfessionals must communicate effectively within and across hospital and primary care settingsProfessional roles should be clarified to ensure effective collaboration and continued high-quality care after hospital discharge.Integrated allied health pathways addressing coordination and communication are needed to ensure seamless transitions.

Effect of standardized EHR-integrated handoff report on intraoperative communication outcomes.

OBJECTIVES: We evaluated the effectiveness and implementability of a standardized EHR-integrated handoff report to support intraoperative handoffs. MATERIALS AND METHODS: A pre-post intervention study was used to compare the quality of intraoperative handoffs supported by unstructured notes (pre) to structured, standardized EHR-integrated handoff reports (post). Participants included anesthesia clinicians involved in intraoperative handoffs. A mixed-method approach was followed, supported by general observations, shadowing, surveys, and interviews. RESULTS: One hundred and fifty-one intraoperative permanent handoffs (78 pre, 73 post) were included. One hundred percent of participants in the post-intervention cohort utilized the report. Compared to unstructured, structured handoffs using the EHR-integrated handoff report led to: (1) significant increase in the transfer of information about airway management (55%-78%, P < .001), intraoperative course (63%-86%, P < .001), and potential concerns (64%-88%, P < .001); (2) significant improvement in clinician satisfaction scores, with regards to information clarity and succinctness (4.5-4.7, P = .002), information transfer (3.8-4.2, P = .011), and opportunities for fewer errors reported by senders (3.3-2.5, P < .001) and receivers (3.2-2.4, P < .001); and (3) significant decrease in handoff duration (326.2-262.3 s, P = .016). Clinicians found the report implementation highly acceptable, appropriate, and feasible but noted a few areas for improvement to enhance its usability and integration within the intraoperative workflow. DISCUSSION AND CONCLUSION: A standardized EHR-integrated handoff report ensures the effectiveness and efficiency of intraoperative handoffs with its structured, consistent format that-promotes up-to-date and pertinent intraoperative information transfer; reduces opportunities for errors; and streamlines verbal communication. Handoff standardization can promote safe and high-quality intraoperative care.

Primary Care Telemedicine and Care Continuity: Implications for Timeliness and Short-term Follow-up Healthcare.

BACKGROUND: The effectiveness of telemedicine by a patient's own primary care provider (PCP) versus another available PCP is understudied. OBJECTIVE: Examine the association between primary care visit modality with timeliness and follow-up in-person healthcare, including variation by visits with the patient's own PCP versus another PCP. DESIGN AND PARTICIPANTS: Cohort study including primary care visits in a large, integrated delivery system in 2022. MEASURES: Outcomes included timeliness (visit completed within 7 days of scheduling) and in-person follow-up (PCP visits, emergency department (ED) visits, hospitalizations) within 7 days of the index PCP visit. Logistic regression measured the association between visit modality (in-person, video, and audio-only telemedicine) with the patient's own PCP or another PCP and outcomes, adjusting for characteristics. KEY RESULTS: Among 4,817,317 primary care visits, 59% were in-person, 27% audio-only, and 14% video telemedicine. Most (71.3%) were with the patient's own PCP. Telemedicine visits were timelier, with modality having a larger association for visits with patient's own PCP versus another PCP (P < 0.001). For visits with patient's own PCPs, return office visit rates were 1.2% for in-person, 5.3% for video, and 6.1% for audio-only. For another PCP, rates were 2.2% for in-person, 7.3% for video, and 8.1% for audio. Follow-up ED visits ranged from 1.4% (in-person) to 1.6% (audio-only) with own PCP, compared to 1.9% (in-person) to 2.3% (audio-only) with another PCP. Differences in return office and ED visits between in-person and telemedicine were larger for visits with another PCP compared to their own PCP (P < 0.001). Follow-up hospitalizations were rare, ranging from 0.19% (in-person with own PCP) to 0.32% (video with another PCP). CONCLUSION: Differences in return office and ED visits between in-person and telemedicine were larger when patients saw a less familiar PCP compared to their own PCP, reinforcing the importance of care continuity.

Improving Care Continuity in Oncology Settings: A Lean Management Approach to Minimize Discharges Without Follow-Up Appointments.

OBJECTIVE: This study aimed to reduce the number of patients discharged without scheduled follow-up appointments by implementing lean management principles. METHODS: Conducted at the Sultan Qaboos Comprehensive Cancer Center in Muscat, Oman, the research utilized a one-group pretest-posttest quasi-experimental design to evaluate the impact of lean management interventions on the rate of patient discharges without follow-up appointments. Strategies such as the Kaizen principle, Gemba Walks, cross-functional collaboration, standard work procedures, and waste reduction were employed to enhance operational efficiency. RESULTS: Spanning from Quarter 3 of 2022 to Quarter 2 of 2023, the study demonstrated a significant decrease in the percentage of patients discharged without planned follow-up appointments. The rate dropped from 9% in September 2022 to 0% in March 2023, with statistically significant differences observed (X2= 65.05, p value=<.0001). CONCLUSION: By effectively implementing lean management principles, this research successfully enhanced care continuity for oncology patients after being discharged.

Developing a prediction model to identify people with severe mental illness without regular contact to their GP - a study based on data from the Danish national registers.

INTRODUCTION: People with severe mental illness (SMI) face a higher risk of premature mortality due to physical morbidity compared to the general population. Establishing regular contact with a general practitioner (GP) can mitigate this risk, yet barriers to healthcare access persist. Population initiatives to overcome these barriers require efficient identification of those persons in need. OBJECTIVE: To develop a predictive model to identify persons with SMI not attending a GP regularly. METHOD: For individuals with psychotic disorder, bipolar disorder, or severe depression between 2011 and 2016 (n = 48,804), GP contacts from 2016 to 2018 were retrieved. Two logistic regression models using demographic and clinical data from Danish national registers predicted severe mental illness without GP contact. Model 1 retained significant main effect variables, while Model 2 included significant bivariate interactions. Goodness-of-fit and discriminating ability were evaluated using Hosmer-Lemeshow (HL) test and area under the receiver operating characteristic curve (AUC), respectively, via cross-validation. RESULTS: The simple model retained 11 main effects, while the expanded model included 13 main effects and 10 bivariate interactions after backward elimination. HL tests were non-significant for both models (p = 0.50 for the simple model and p = 0.68 for the extended model). Their respective AUC values were 0.789 and 0.790. CONCLUSION: Leveraging Danish national register data, we developed two predictive models to identify SMI individuals without GP contact. The extended model had slightly better model performance than the simple model. Our study may help to identify persons with SMI not engaging with primary care which could enhance health and treatment outcomes in this group.

Management of drug-resistant tuberculosis in Indonesia: a four-year cascade of care analysis.

Background: In Indonesia, drug resistance testing for TB largely relies on Xpert MTB/RIF, and it is unknown what proportion of drug-resistant (DR) TB is adequately diagnosed and treated. Methods: We conducted a cascade of care analysis on a cohort of presumptive rifampicin-resistant (RR) TB patients registered in 2015-2018 in a tertiary hospital in Indonesia. Estimated incidences of (presumptive) DR-TB cases were assumption-based using global reports. Data on diagnosis and consecutive cascades steps, including their timing were collected from national electronic registers, and medical records. We described a secondary cascade for patients receiving treatment not supported by phenotypic drug susceptibility testing (pDST). Factors associated with delay and loss between diagnosis and treatment were identified using logistic regression. Findings: Less than a third of estimated incident TB cases at risk of DR-TB were identified as presumptive DR-TB case and tested, and 9.8% (982/10,065) of estimated true DR-TB cases was diagnosed. Of those diagnosed, only 45.1% (443/982) had treatment regimens supported by pDST results, but this did not significantly influence treatment outcomes. Only 25.5% (250/982) of diagnosed patients completed all steps of the cascade including successful treatment. Delays between diagnosis and treatment were substantial, and more common among those referred from a primary healthcare facility, and among those who were employed, living outside of Bandung, and reporting engagement with the private sector. Interpretation: The DR-TB care cascade in this urban setting in Indonesia is characterized by substantial attrition and delays. Strategies to increase access to DR-TB diagnosis accompanied by optimisation of clinical care could substantially improve outcomes and reduce onward transmission. Funding: Radboud university medical center and University of Otago.

[Interlevel incident management: The experience of a primary care district]. / Gestión de incidencias interniveles. La experiencia de un distrito de atención primaria.

AIM: Determine the prevalence and define the profile of interlevel incidences (ININ) between primary care (PC) and hospital (HC). DESIGN: Multicenter cross-sectional descriptive study. SITE: Primary care. PARTICIPANTS: Professionals from a Health District and its reference hospitals. INTERVENTIONS: ININ are errors in communication between PC and HC professionals derived from administrative, pharmaceutical or clinical procedures not resolved during the formal interlevel communication processes, which requires a coordinated and validated response from the health care directions to not overload the family physician. MAIN MEASUREMENTS: ININ by category, hospital services and health centers, total and validated, relative to the total number of referrals, and the reason for the ININ. RESULTS: We detected 2011 ININs (3.36%) among the 59.859 referrals, although only 1684 were validated (83.7%). Most were administrative (59.5%), followed by pharmaceutical (24.2%), clinical (10.2%) and reverse (6.1%). 41.3% of the clinical ININs were grouped around 5 hospital specialties, and 45.9% in 5 health centers. The main reasons for clinical ININ were non-prescription of the recommended pharmacological treatment in outpatient clinics or on hospital discharge (27.3%), request for referral to another hospital specialist (27.9%), or request to referral in person to patients who had already been referred by teleconsultation (17.8%). CONCLUSIONS: 3.36% of interlevel referrals are accompanied by incidents and 83.7% are validated and processed. It is necessary to develop ININ management tools to guarantee safe healthcare and debureaucratize PC.

The role of nursing care continuity report in predicting length of hospital stay in older people: A retrospective cohort study.

BACKGROUND: The Nursing Care Continuity Report (NCCR) is a tool for evaluating the quality of nursing care during hospital admission. AIM: To explore the role of the NCCR in predicting longer length of stay (LOS) in older adults (≥65 years) admitted to a tertiary hospital and determine possible clinical differences at discharge between patients who had a short LOS (≤7 days) and a prolonged LOS (>7 days). RESEARCH DESIGN AND SETTING: A retrospective cohort study was conducted including all patients with a completed NCCR admitted to the hospital between 2015 and 2019. Sociodemographic data, risk of pressure injuries, level of dependence, presence and intensity of pain, and presence and type of pressure injury were the variables registered in the NCCR. RESULTS: A total of 41,354 patients were included in this study, with a mean age of 78 years, of whom 47% were female. At admission, 21% of patients were at potential risk of developing pressure ulcers. Age, admission to the internal or respiratory medicine unit, and having at least medium risk of developing pressure ulcers were the predictors of prolonged LOS using a random sample of 950 patients. At discharge, patients with prolonged LOS presented higher risk of pressure ulcers and a higher level of dependency and were more likely to present hospital-acquired pressure ulcers. CONCLUSIONS: Older adults from the internal or respiratory medicine unit who exhibited higher risk of pressure ulcers were related to a prolonged LOS, a higher level of dependency, and hospital-acquired ulcers at hospital discharge. RELEVANCE TO CLINICAL PRACTICE: Identifying clinical data that have a greater relationship with LOS could be a useful tool for nursing management and for the implementation of strategies to prevent adverse events during hospitalisation. NO PATIENT OR PUBLIC CONTRIBUTION: No direct patient contact was made during the data collection.

Predictors of Physician Follow-Up Care Among Patients Affected by an Incident Mental Disorder Episode in Quebec (Canada).

OBJECTIVES: This study identified predictors of prompt (1+ outpatient physician consultations/within 30 days), adequate (3+/90 days) and continuous (5+/365 days) follow-up care from general practitioners (GPs) or psychiatrists among patients with an incident mental disorder (MD) episode. METHODS: Study data were extracted from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), which covers 98% of the population eligible for health-care services under the Quebec (Canada) Health Insurance Plan. This observational epidemiological study investigating the QICDSS from 1 April 1997 to 31 March 2020, is based on a 23-year patient cohort including 12+ years old patients with an incident MD episode (n = 2,670,133). Risk ratios were calculated using Robust Poisson regressions to measure patient sociodemographic and clinical characteristics, and prior service use, which predicted patients being more or less likely to receive prompt, adequate, or continuous follow-up care after their last incident MD episode, controlling for previous MD episodes, co-occurring disorders, and years of entry into the cohort. RESULTS: A minority of patients, and fewer over time, received physician follow-up care after an incident MD episode. Women; patients aged 18-64; with depressive or bipolar disorders, co-occurring MDs-substance-related disorders (SRDs) or physical illnesses; those receiving previous GP follow-up care, especially in family medicine groups; patients with higher prior continuity of GP care; and previous high users of emergency departments were more likely to receive follow-up care. Patients living outside the Montreal metropolitan area; those without prior MDs; patients with anxiety, attention deficit hyperactivity, personality, schizophrenia and other psychotic disorders, or SRDs were less likely to receive follow-up care. CONCLUSION: This study shows that vulnerable patients with complex clinical characteristics and those with better previous GP care were more likely to receive prompt, adequate or continuous follow-up care after an incident MD episode. Overall, physician follow-up care should be greatly improved.

Delayed discharges at a tertiary rehabilitation centre in Saudi Arabia: contributing factors and cost impact.

There are various challenges in discharging hospitalized patients with disabilities. Discharge process for individuals with disabilities is multifactorial and can vary from one health system to another. The current study is aimed to explore the factors contributing to delayed discharges and to determine the number of exceeded bed days and subsequent cost impact at a government rehabilitation facility in Saudi Arabia. This retrospective cohort study was conducted at the Rehabilitation Hospital of King Fahad Medical City, Riyadh. All the 2285 discharges from inpatient rehabilitation from August 2011 to March 2017 were included in the study. Patients with delayed discharge were identified. Information about the diagnosis and reasons for delayed discharge was obtained from the rehabilitation hospital bed utilization data. The cost impact was calculated based on the number of days patients stayed beyond the estimated length of stay for each diagnosis. Of the 2285 discharges, 531 (23.3%) were delayed. The most common clinical conditions of patients with delayed discharge included spinal cord injury (n = 168, 31.6%) and traumatic brain injury (n = 145, 27.3%). The factors that led to delayed discharges were medical complications (n = 352, 66.7%), organizational factors (n = 83, 15.7%), family factors (n = 46, 8.7%), and external factors (n = 46, 8.7%). A total of 21 817 hospital bed days were exceeded, with an approximate estimated cost of 80 million Saudi Arabian Riyals. Early rehabilitation and enhancement of the discharge process may significantly decrease delayed discharge rates. Strategies need to be adapted to identify patients at risk of delayed discharge based on the factors highlighted in this study. Development of long-term care capacity, community services, and optimizing family and social support can promote timely discharge.

Care Retention Among Veterans with Serious Mental Illness who were once lost-to-Veterans Health Administration care.

OBJECTIVE: To evaluate care retention among Veterans with serious mental illness (SMI) who were lost to Veterans Health Administration (VHA) care for at least one year and subsequently returned to VHA care via the SMI Re-Engagement program, an outreach program for Veterans with SMI who are lost-to-care. METHODS: For the 410 Veterans with SMI who returned to care via SMI Re-Engagement between April 4th, 2016 and January 31, 2018, we assessed VHA in-person and telehealth utilization (overall, primary care, mental health care) for two years following the date of return to care. RESULTS: Care retention was common: 70.2% of Veterans had at least one encounter in each year of the two-year follow-up period and an additional 22.7% had at least one encounter during one of the two years. During the two-year follow-up period, 72.4% of Veterans had at least one primary care encounter and 70.7% of Veterans had at least one mental health care encounter. Adjusted binomial logistic regression analyses found a return-to-care encounter in primary care (OR = 2.70; 95% CI: 1.34, 5.42) predicted primary care retention, and a return-to-care encounter in mental health care (OR = 4.01; 95% CI: 2.38, 6.75) predicted mental health care retention. CONCLUSION: Most Veterans who return to care via the SMI Re-Engagement program remain in VHA care for the subsequent two years.

Evaluating the association of COVID-19 restrictions on discharge planning and post-discharge outcomes in the community hospital and Singapore regional health system.

Objectives: The COVID-19 is a global health issue with widespread impact around the world, and many countries initiated lockdowns as part of their preventive measures. We aim to quantify the duration of delay in discharge to community from Community Hospitals, as well as quantify adverse patient outcomes post discharge pre and during lockdown period. Design and methods: We conducted a before-after study comparing the length of stay in Community Hospitals, unscheduled readmissions or Emergency Department attendance, patients' quality of life using EQ5D-5l, number and severity of falls, in patients admitted and discharged before and during lockdown period. Results: The average length of stay in the lockdown group (27.77 days) were significantly longer than that of the pre-lockdown group (23.76 days), p = 0.003. There were similar proportions of patients with self-reported falls post discharge between both groups. Patients in the pre-lockdown group had slightly better EQ-5D-5l Index score at 0.55, compared to the lockdown study group at 0.49. Half of the patients in both groups were referred to Community Care Services on discharge. Conclusion: Our study would help in developing a future systematic preparedness guideline and contingency plans in times of disease outbreak and other similar public health emergencies.

Experiences and Perceptions of Telehealth Visits in Diabetes Care During and After the COVID-19 Pandemic Among Adults With Type 2 Diabetes and Their Providers: Qualitative Study.

BACKGROUND: Since the COVID-19 pandemic, telehealth has been widely adopted in outpatient settings in the United States. Although telehealth visits are publicly accepted in different settings, little is known about the situation after the wide adoption of telehealth from the perspectives of adults with type 2 diabetes mellitus (T2D) and their providers. OBJECTIVE: This study aims to identify barriers and facilitators of maintaining continuity of care using telehealth for patients with T2D in a diabetes specialty clinic. METHODS: As the second phase of a multimethod study to understand missed appointments among adults with T2D, we conducted semistructured, individual, in-depth phone or Zoom interviews with 23 adults with T2D (14/23, 61% women; mean age 55.1, SD 14.4, range 35-77 years) and 10 providers from diabetes clinics in a tertiary academic medical center in Maryland. Interviews were audio-recorded, transcribed, and analyzed using thematic content analysis by the research team. RESULTS: Adults with T2D and their providers generally reported positive experiences with telehealth visits for diabetes care with some technical challenges resulting in the need for in-person visits. We identified the following 3 themes: (1) "perceived benefits of telehealth visits," such as convenience, time and financial efficiencies, and independence from caregivers, benefits shared by both patients and providers; (2) "perceived technological challenges of telehealth visits," such as disparities in digital health literacy, frustration caused by unstable internet connection, and difficulty sharing glucose data, challenges shared by both patients and providers; and (3) "impact of telehealth visits on the quality of diabetes care," including lack of diabetes quality measures and needs and preferences for in-person visits, shared mainly from providers' perspectives with some patient input. CONCLUSIONS: Telehealth is generally received positively in diabetes care with some persistent challenges that might compromise the quality of diabetes care. Telehealth technology and glucose data platforms must incorporate user experience and user-centered design to optimize telehealth use in diabetes care. Clinical practices need to consider new workflows for telehealth visits to facilitate easier follow-up scheduling and lab completion. Future research to investigate the ideal balance between in-person and telehealth visits in diabetes care is warranted to enhance the quality of diabetes care and to optimize diabetes outcomes. Policy flexibilities should also be considered to broaden access to diabetes care for all patients with T2D.

Continuity and care coordination of primary health care: a scoping review.

BACKGROUND: Healthcare coordination and continuity of care conceptualize all care providers and organizations involved in health care to ensure the right care at the right time. However, systematic evidence synthesis is lacking in the care coordination of health services. This scoping review synthesizes evidence on different levels of care coordination of primary health care (PHC) and primary care. METHODS: We conducted a scoping review of published evidence on healthcare coordination. PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science and Google Scholar were searched until 30 November 2022 for studies that describe care coordination/continuity of care in PHC and primary care. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines to select studies. We analysed data using a thematic analysis approach and explained themes adopting a multilevel (individual, organizational, and system) analytical framework. RESULTS: A total of 56 studies were included in the review. Most studies were from upper-middle-income or high-income countries, primarily focusing on continuity/care coordination in primary care. Ten themes were identified in care coordination in PHC/primary care. Four themes under care coordination at the individual level were the continuity of services, linkage at different stages of health conditions (from health promotion to rehabilitation), health care from a life-course (conception to elderly), and care coordination of health services at places (family to hospitals). Five themes under organizational level care coordination included interprofessional, multidisciplinary services, community collaboration, integrated care, and information in care coordination. Finally, a theme under system-level care coordination was related to service management involving multisectoral coordination within and beyond health systems. CONCLUSIONS: Continuity and coordination of care involve healthcare provisions from family to health facility throughout the life-course to provide a range of services. Several issues could influence multilevel care coordination, including at the individual (services or users), organizational (providers), and system (departments and sectors) levels. Health systems should focus on care coordination, ensuring types of care per the healthcare needs at different stages of health conditions by a multidisciplinary team. Coordinating multiple technical and supporting stakeholders and sectors within and beyond health sector is also vital for the continuity of care especially in resource-limited health systems and settings.

Frenillo lingual corto: resultados de una intervención para mejorar la continuidad asistencial / Short lingual frenulum: results of an intervention to improve continuity of care

Introducción: la discrepancia entre los criterios de derivación de pacientes con diagnóstico de frenillo lingual corto/anquiloglosia (FLC/A) a la consulta de cirugía plástica infantil desde Atención Primaria (AP) y los criterios propuestos por parte de los profesionales de la unidad para la realización de frenotomía lingual motivó la creación de un tríptico informativo sobre la patología para intentar homogeneizar la actuación entre niveles asistenciales. El objetivo principal del trabajo consiste en analizar el impacto de la intervención en las derivaciones de estos pacientes a atención especializada (AE). Material y métodos: redacción y divulgación de la información entre los profesionales de AP adscritos al área de salud de nuestro hospital. Análisis retrospectivo de las derivaciones a AE y de la actuación llevada a cabo en consulta en los 2 años previos al envío de la información. Análisis prospectivo de las consultas atendidas en el año posterior a la difusión del tríptico. Comparación de ambos periodos. Resultados: se analizaron 874 consultas; de ellas, el 59,6% se realizó previa difusión del tríptico. Las derivaciones se ajustaron a los criterios propuestos por la UCPI (Unidad de Cirugía Plástica Infantil) en un 61,9% de los casos, observándose una reducción significativa en los pacientes mal derivados entre ambos periodos de tiempo (41,8% vs. 32,6%). Se comprobó una disminución estadísticamente significativa en el número de pacientes derivados sin un problema funcional claro asociado al FLC (34,4% vs. 23,3%). Conclusiones: la difusión de un tríptico informativo sobre FLC/A ha demostrado ajustar las derivaciones hechas desde AP a los criterios propuestos para frenotomía lingual en la UCPI de nuestro hospital (AU)

Introduction: we created an informative triptych about short lingual frenulum/ ankyloglossia (SLF/A) to avoid discrepancy in the referral criteria of patients to the pediatric plastic surgery consultation from primary care (PC). The main objective is to analyze the impact of this intervention on the referrals to specialized care (SC).Material and methods: the information was sent to the primary care professionals attached to the health area of our hospital. We performed a retrospective analysis of the referrals to SC in the 2 years prior sending the information. We compared these results with the prospective analysis of the consultations attended in the year after sending the triptych.Results: we analyzed 874 consultations. 59.6% of them were attended prior sending the information. 61.9% of the referrals adjusted to the proposed criteria for lingual frenotomy, observing a significant reduction in the wrongly referred patients between the compared periods of time (41.8% vs 32.6%). We also found a significant reduction in the number of patients with no functional problem associated to the SLF (34.4% vs 23.3%).Conclusions: our informative triptych about SLF/ ankyloglossia has adjusted referrals from PC to the proposed criteria for lingual frenotomy in our hospital. (AU)

What can we learn from experiences in general practice during the COVID-19 pandemic? A qualitative study.

BACKGROUND: Experiences with organizational changes in daytime general practices and out-of-hours (OOH) services during the COVID-19 pandemic may help to address the challenges in general practice care that were already a concern before the crisis. This study aimed to describe these experiences and the potential usefulness of the organizational changes for future general practice care and any future pandemics. METHODS: Semi-structured interviews were performed among 11 directors of OOH services, and 19 (locum) general practitioners (GPs) or practice managers, who were purposively sampled. Video or telephone interviews were performed in two rounds: between November 2020 and January 2021 and between May 2021 and August 2021. The data were analyzed using thematic analysis methods. RESULTS: Three themes emerged from the data: (1) Changes in the triage procedures; in GP practices and OOH services, stricter triage criteria were implemented, and GPs were more actively involved in the triage process. These measures helped to reduce the number of 'low urgency' face-to-face consultations. (2) Changes in GP care; there was a shift towards video and telephone consultations, allowing GPs to spend more time with patients during the remaining face-to-face consultations. For chronic patients, the shift towards telemonitoring appeared to encourage self-care, and postponing face-to-face consultations for regular checkups appeared to be unproblematic for stable patients. (3) Coordination of GP care and information communication flow during the COVID-19 pandemic; OOH directors perceived a lack of consistency in the information from various governmental and non-governmental parties on containment measures and guidelines related to COVID-19, making it difficult to act on them. The COVID-19 pandemic intensified collaboration between GPs, OOH services, and other healthcare professionals. CONCLUSIONS: The results of this study indicate that some of the organizational changes, such as stricter triage, remote consultations, and changes in managed care of chronic patients, may help in tackling the pre-existing challenges in GP care from before the COVID-19 pandemic. However, more extensive research and continuous monitoring are necessary to establish the effects on patients and their health outcomes. To navigate future pandemics, the intensified collaboration between health professionals should be maintained, while there is considerable room for improvement in the provision of unambiguous information.

Self, at Home, and Digital if Possible, Drivers to Population Health Management.

The Dutch healthcare system is known for its strong emphasis on primary care and a decentralized approach to healthcare delivery. This system will have to adapt in view of the ever-increasing demand and overburdened caregivers, because otherwise it will eventually be insufficient to offer patients adequate care at sustainable costs. The focus must shift from the volume and profitability of all parties involved to a collaborative model for achieving the best outcomes for patients. Rivierenland Hospital in Tiel is preparing for a shift from treating sick patients to promoting the general health and well-being of the population in the region. This "population health" approach aims to maintain the health of all citizens. This transformation to a value-based healthcare system, centered on the needs of patients, requires a complete overhaul of the current systems and its entrenched interests and practices. The regional healthcare transformation requires a digital transformation characterized by several IT implications, such as facilitating patient's access EHR data and sharing information at patient journey level to support the partners involved in the regional care and cure for patients. The hospital is planning to categorize its patients in order to establish an information database. This will help the hospital and its regional partners to identify opportunities for regional comprehensive care solutions as part of their transition plan.

Quality and cost of healthcare services in patients with diabetes in Iran: Results of a nationwide short-term longitudinal survey.

Aims: To investigate the journey of patients with diabetes in the healthcare system using nationally-representative patient-reported data. Methods: Participants were recruited using a machine-learning-based sampling method based on healthcare structures and medical outcome data and were followed up for three months. We assessed the resource utilization, direct/indirect costs, and quality of healthcare services. Results: One hundred fifty-eight patients with diabetes participated. The most utilized services were medication purchases (276 times monthly) and outpatient visits (231 times monthly). During the previous year, 90% of respondents had a laboratory fasting blood glucose assessment; however, less than 70% reported a quarterly follow-up physician visit. Only 43% had been asked about any hypoglycemia episodes by their physician. Less than 45% of respondents had been trained for hypoglycemia self-management. The annual average health-related direct cost of a patient with diabetes was 769 USD. The average out-of-pocket share of direct costs was 601 USD (78.15%). Medication purchases, inpatient services, and outpatient services summed up 79.77% of direct costs with a mean of 613 USD. Conclusion: Healthcare services focused solely on glycemic control and the continuity of services for diabetes control was insufficient. Medication purchases, and inpatient and outpatient services imposed the most out-of-pocket costs.

Continuity of Care and Coordination of Care: Can they Be Differentiated?

Introduction: Both care continuity and coordination are considered essential elements of health care system. However, little is known about the relationship between care continuity and coordination. This study aimed to differentiate the concepts of care continuity and coordination by developing and testing the reliability and validity of the Combined Outpatient Care Continuity and Coordination Assessment (COCCCA) questionnaire under the universal coverage health care system in Taiwan from a patient perspective. Methods: Face-to-face interviews were conducted nationwide with community-dwelling older adults selected via stratified multistage systematic sampling with probability-proportional-to-size process. A total of 2,144 subjects completed the questionnaire, with a response rate of 44.67%. Results: The 16 items of the COCCCA questionnaire were identified via item analysis and principal component analysis (PCA). The PCA generated five dimensions: three continuity-oriented (interpersonal, information sharing and longitudinal between patients and physicians) and two coordination-oriented (information exchange and communication/cooperation among multiple physicians). The second-order confirmatory factor analysis supported the factor structure and indicated that distinct constructs of care continuity and coordination can be identified. Conclusion: The COCCCA instrument can differentiate the concepts of care continuity and care coordination and has been demonstrated to be valid and reliable in outpatient care settings from a patient perspective.